Provider Demographics
NPI:1144902859
Name:OCHOA-CARRASCO, EFFIEJANE (PTA)
Entity type:Individual
Prefix:
First Name:EFFIEJANE
Middle Name:
Last Name:OCHOA-CARRASCO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:EFFIE
Other - Middle Name:
Other - Last Name:OCHOA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:4540 AMBERLEY RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-1657
Mailing Address - Country:US
Mailing Address - Phone:702-266-7304
Mailing Address - Fax:
Practice Address - Street 1:6900 N PECOS RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-4400
Practice Address - Country:US
Practice Address - Phone:702-791-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-1109225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant